Privilege and deprivation in Detroit: infant mortality and the Index of Concentration at the Extremes

Maeve E Wallace; Joia Crear-Perry; Carmen Green; Erica Felker-Kantor; Katherine Theall

doi:10.1093/ije/dyy149

Privilege and deprivation in Detroit: infant mortality and the Index of Concentration at the Extremes

Int J Epidemiol. 2019 Feb 1;48(1):207-216. doi: 10.1093/ije/dyy149.

Authors

Maeve E Wallace^{1

2}, Joia Crear-Perry², Carmen Green², Erica Felker-Kantor¹, Katherine Theall¹

Affiliations

¹ Mary Amelia Douglas-Whited Community Women's Health Education Center, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
² National Birth Equity Collaborative, New Orleans, LA, USA.

PMID: 30052993
DOI: 10.1093/ije/dyy149

Abstract

Background: Enhanced understanding of spatial social polarization as a determinant of infant mortality is critical to efforts aimed at advancing health equity. Our objective was to identify associations between spatial social polarization and risk of infant death.

Methods: We conducted a cross-sectional analysis of all birth records issued to non-Hispanic (NH) Black and White women in Wayne County, MI, from 2010 to 2013 (n = 84 159), including linked death records for deaths occurring at less than 1 year of age. Spatial social polarization was measured in each Census tract of maternal residence (n = 599) using the Index of Concentration at the Extremes (ICE)-a joint measure of racial and economic segregation-estimated from American Community Survey 2009-2013 data. Log-Poisson regression models quantified relative risk (RR) of infant death (all-cause and cause-specific) associated with tertiles of the index, adjusting for maternal demographic characteristics and tract-level poverty.

Results: The crude infant-mortality rate was more than 2-fold higher among NH Black infants compared with NH Whites (14.0 vs 5.9 deaths per 1000 live births). Half of the 845 infant deaths (72% NH Black, 28% NH White) occurred in tracts in the lowest tertile of the ICE distribution, representing areas of relative deprivation. After adjustments, risk of death among infants in the lowest tertile was 1.46 times greater than those in the highest tertile (adjusted infant-mortality rate = 3.7 deaths per 1000 live births in highest tertile vs 5.4 deaths per 1000 live births in lowest tertile, relative risk = 1.46, 95% confidence interval = 1.02, 2.09). Patterns of associations with the index differed by cause of death.

Conclusions: These findings suggest efforts to support equitable community investments may reduce incidents of death and the disproportionate experience of loss among NH Black women.

Keywords: health equity; infant mortality; social segregation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Black or African American / statistics & numerical data*
Cause of Death*
Cross-Sectional Studies
Humans
Infant
Infant Mortality / trends*
Infant, Newborn
Michigan / epidemiology
Poverty Areas*
Residence Characteristics
Socioeconomic Factors
White People / statistics & numerical data*